The accumulation of extra fat is harmful for the liver and is referred to as fatty liver disease or hepatic steatosis. While alcoholic liver disease (ALD) is brought on by consumption of alcohol, nonalcoholic fatty liver disease (NAFLD) is not caused by alcohol. Both ALD and NAFLD are major health issues globally.

Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat builds up in your liver. This buildup of fat is not caused by heavy alcohol use. When heavy alcohol use causes fat to build up in the liver, this condition is called alcohol-associated liver disease Using ALT level as a marker for severe NAFLD would consider high-risk patients as mild cases, even though there is still the risk of progressive and severe hepatic disease.

Roughly a quarter of people with liver cirrhosis develop palmar erythema – a reddening of the skin on the palms. Dark urine. Urine that is dark orange, amber, cola-coloured or brown can be a sign of liver disease. The colour is due to too much bilirubin building up because the liver isn’t breaking it down normally. A urobilinogen in urine test measures the amount of urobilinogen in your urine (pee). Normal urine contains some urobilinogen. Too much urobilinogen in urine may be a sign of a liver disease, such as hepatitis or cirrhosis, or certain types of anemia. In a small number of cases, it can progress and eventually lead to liver damage if not detected and managed.

The main stages of NAFLD are:

1. simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason
2. non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver has become inflamed
3. fibrosis – where persistent inflammation causes scar tissue around the liver and nearby blood vessels, but the liver is still able to function normally
4. cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer

According to the National Institute of Diabetes and Digestive and Kidney Diseases  , people with certain health conditions have a higher riskTrusted Source of developing NAFLD than others. This includes:
• obesity
• type 2 diabetes or insulin resistance
• atypical levels of fat in the blood, including cholesterol and triglycerides
• metabolic syndrome

THE EFFECT OF EXERCISE ON THE LIVER IS INDEPENDENT OF WEIGHT LOSS
Importantly, the decrease in the hepatic fat content was achieved even when overall weight loss was not observed in a multitude of studies which is consistent with the idea that exercise has a direct effect on the liver. However, the mechanisms by which exercise reduces liver fat are still greatly unknown. The next sections of this review summarize the available evidence on possible metabolic and molecular pathways involved in the reduction of hepatic fat by exercise.
From the available literature, it is evident that physical exercise has a beneficial effect on NAFLD. Various regimens of aerobic and resistance training have been shown to reduce hepatic fat content through improvements in insulin resistance, liver fatty acid metabolism, liver mitochondrial function, and activation of inflammatory cascades. These data provide justification for the current guidelines that recommend an exercise regimen that fits with the patient’s individual abilities and preferences, in order to facilitate long-term compliance with a more active lifestyle.

Gut microbiota and Chronic Liver Diseases

The homeostasis of intestinal flora plays an important role in the human body and can be involved in the regulation of various functions of the human body. The homeostasis of intestinal flora has a protective effect on the liver. The liver is directly connected to the intestines through the portal vein, which enables the gut microbiota and gut-derived products to influence liver health. There is accumulating evidence of decreased gut flora diversity and alcohol sensitivity in patients with various chronic liver diseases, including non-alcoholic/alcoholic liver disease, chronic hepatitis virus infection, primary sclerosing cholangitis and liver cirrhosis. Increased intestinal mucosal permeability and decline in barrier function were also found in these patients.  There is much evidence that shows that intestinal permeability is closely related to chronic liver disease.. The intestinal permeability changes are associated with gut microbiota (GM) involved in developing chronic liver disease . The gut microbiota closely interacts with a variety of immune cells in the liver. SIBO in liver cirrhosis is partly due to the movement of the small intestine and the decrease of the time passing through the intestine

The type of gut bacteria which is closely related to cirrhosis and has bee studied; is a vast number and species of microorganisms that colonize in the human intestines, the healthy gut microbiome is dominated by only some bacterial species, and the quantitative and qualitative changes in cirrhosis, including increased Proteobacteria and Fusobacteria and reduced Bacteroidetes

Are NAFLD and alcoholic fatty liver disease reversible? 

Lifestyle : Diet guidelines
We recommend the Mediterranean diet (MD) to our liver patients. The studies’ findings disclose that the MedDiet’s beneficial effects could be primarily related to its anti-inflammatory and anti-oxidant properties. The MD include many beneficial foods like olive oil or its polyphenols. The MD has recently emerged as a suitable model of sustainable nutrition, in which nutrition, local foods, biodiversity, culture, and sustainability are strictly interconnectedAccording to a 2022 systematic review , lifestyle modifications are usually the first line of treatment . All these dietetic guidelines from a nutrition specialist

My Thoughts:

As a Clinical Dietitian / Nutritionist , I understand that addressing a chronic health condition requires a comprehensive approach and consistent adherence to treatment protocols. There is no quick fix or magic formula to remedy an issue that has developed over time. It is crucial to follow the guidance of a specialist in order to effectively manage and potentially reverse complex clinical conditions. With dedication and professional support, positive outcomes can be achieved through a diligent and continuous effort.